Massachusetts health plan may be a model for Obama

Tuesday

Nov 25, 2008 at 12:01 AMNov 25, 2008 at 6:52 AM

When President-elect Barack Obama’s administration tackles universal health care coverage, Massachusetts will likely serve as the national model. But they will also discover a chief problem: a shortage of primary care doctors.

But as local health care experts have pointed out, the nation will soon grapple with Massachusetts’ chief problem in the delivery of coverage: a lack of primary care doctors.

This was the theme of a recent panel discussion at Boston Children’s Hospital, where health care experts discussed the problems still facing the two-year-old state initiative requiring health insurance of every resident.

Only 25 percent of doctors in Massachusetts are in primary care, and less than 1 percent of medical students choose to be primary care physicians, according to Dr. David Chin, managing partner of Price Waterhouse Cooper’s Global Healthcare Research Institute.

It’s a problem that’s been growing for a few years, and one that local hospitals and health care experts say has no easy answer.

Beverly Archambeault, director of physician recruitment and retention at Jordan Hospital in Plymouth, said she didn’t find a single primary care doctor at a recruiting conference in Boston earlier this year.

“It’s simply not attractive to go into primary care,” Archambeault said. “We have very high malpractice rates, low (school loan) reimbursements, and they are overburdened with paperwork through insurance requirements.”

Many local hospitals work toward close relationships with physician practice groups, but it’s often difficult to keep referrals to one network, as Signature does.

At Jordan Hospital, Archambeault predicted that the physician shortage may lead to an increased demand for nurse practitioners before more doctors can be recruited.

“With the day-to-day flu, bumps, and scrapes, I believe you will see nurse practitioners more and more,” Archambeault said.

As for immediate solutions, Archambeault said, “If I were in charge, I’d say we need to do something about malpractice reform, increase the ability to reduce educational debt.”

The state took steps to address some of these issues this summer, when Gov. Deval Patrick signed legislation creating a loan forgiveness program for physicians and nurses who agree to practice primary care in medically under-served areas, such as western Massachusetts.

The legislation also provided greater tuition incentives for medical students at the University of Massachusetts who agree to go into primary care in the state for four years.

Karen Nelson, the Massachusetts Hospital Association’s senior vice president for clinical affairs, said the new legislation means the state is serious about addressing the problem.

“They have identified loan repayment and incentive programs to get these primary care physicians to work in under-served areas,” said Nelson. “But recruitment areas are tougher and as we all know, Massachusetts is an expensive place to live.”

“If we could figure out how to change the export industry (of doctors graduating area schools and leaving the state) we have right now, that would be a huge help.”